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Ann Thorac Surg 2007;83:1172-1174
© 2007 The Society of Thoracic Surgeons

Case Reports

Unusual Complication of Heparin-Induced Thrombocytopenia After Mitral Valve Surgery: Spontaneous Rupture of Spleen

Christina Mitchell, MDa, Catherine A. Riley, MDb, Bobbak Vahid, MDb,*

a Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
b Department of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania

Accepted for publication August 28, 2006.

* Address correspondence to Dr Vahid, 834 Walnut St, Suite 650, Philadelphia, PA 19107 (Email: bobbak.vahid{at}mail.tju.edu).

A 64-year-old man presented with cardiac tamponade 2 weeks after mitral valve surgery. The patient was anticoagulated for persistent atrial fibrillation after cardiac surgery. A pericardial catheter was placed. Five days after presentation the patient was started on intravenous heparin infusion. The patient had abdominal pain and hypotension develop. A splenic hematoma was diagnosed and a splenectomy was performed. Pathology showed multiple fibrin thrombi in the spleen. The heparin-associated antibodies were detected. Heparin-induced thrombocytopenia is a potentially fatal condition in patients requiring heparin after cardiac surgery. Evaluation for heparin-associated antibodies in these patients may be warranted before heparin therapy.






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Copyright © 2007 by The Society of Thoracic Surgeons.